Question 2.

How do skill/abilities and cognition impact perseverative play/repetitive play?

 Ducks in a row
(ed3602autism.wikispaces.com)

In a study conducted by D.K. Wong, (Wong, 2001) three major cognitive theories were proposed to account for the behavioral symptoms of autism: 

• Theory of Mind  
• Central Coherence Theory
• Executive Dysfunction

These three theories have had varying degrees of success in accounting for the repetitive behaviors, language impairments, and communicative difficulties which are symptomatic of autism. However the study concluded that deficits in Executive Functioning showed the strongest correlation with perseveration and repetitive behaviors.

Executive function is the ability to initiate an idea, make a plan, draw from memory, and carry out that plan. A child with an ASD who has poor executive function will be impacted by an inability to play constructively. The skills inherent in executive function require that the child build a fund of knowledge about his environment and the objects in it. This fund of knowledge is built and developed through play and interaction with their environment.

Without these cognitive functions the child will lack the ability to generate an idea, think imaginatively, create a mental picture or plan, or retrieve information from memory and carry out that plan.

As a result of these deficits children with an ASD will:

• Do less exploration and play with fewer toys.
• Tend not to engage in pretend or imaginative play.
• Tend not to use toys in novel ways.
• Display a lack of imagination that limits exploration and play with toys.
• Become preoccupied with certain aspects or sensory features of a particular toy like the spinning wheels of a car.
• Engage in perseverative restrictive repetitive play patterns. 

How do play patterns and self-injurious behaviors impact learning and daily function?

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The lack of constructive play patterns reduces learning opportunities. Restrictive repetitive play means that the child misses out on exploration of the uses of toys and their actions, cause/effect, and affordances. While engaging in repetitious play and self-injurious behaviors a child misses out on social and learning opportunities. It can impact their ability to attend, learn and develop imagination and pretend play.

Repetitious play and self-injurious behaviors can draw negative attention to the child causing further social isolation. A preoccupation with repetitious play and self-injurious behaviors has also been shown to impact language development and as a result communication and social skills.

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References:

Honey, E., Leekam, S., & Turner, M. (2006, 10 27). Repetitive Behaviour and Play in Typically Developing Children. Journal of Autism and Developmental Disorders, pp. 1107-1115.

Miller Kuhaneck, H., & Watling, R. (Eds.). (2010). Autism: a Comprehensive Occupational Therapy Approach (3rd ed.). Bethesda, MD, USA: AOTA Press.

Turner, M. (1999). Annotation: Repetitive Behaviour in Autism: A Review. Journal of Child Psychology and Psychiatry, 839-849.

Wong, D. (2001). Executive functioning and repetitive behaviours in autism. Australian Society for the Study of Brain Impairment. Magnetic Island, Queensland: University of Western Australia.

Introduction    

      
     

 Repetitive Play Patterns, Perseveration and Self-injurious Behaviors

Question 1.

Autism spectrum disorder (ASD) is a range of complex neurodevelopment disorders, characterized by social impairments, communication difficulties, and restricted and stereotyped patterns of behavior which include repetitive play patterns, perseveration and self-injurious behaviors.

Image: Louisa Stokes, FreeDigitalPhotos.net

Repetitive play patterns, perseveration and self-injurious behaviors are core features of the ASD but what exactly are they and how do they impact a child with an ASD?

The term ‘‘repetitive behavior’’ is an umbrella term used to refer to the broad range of behaviors linked by repetition, rigidity, and invariance. 

Repetitive play patterns are frequently seen in children with ASD.  Play is an integral part of childhood development. If play value is defined as “how much play a child gets out of something” then the child with an ASD frequently does not get the same benefits from play that a typically developing child would.

In play the value of a toy is directly related to how many different options it offers for exploration and learning, for example nesting cups. Nesting cups can be nested inside each other, made into a tower, filled with other objects that can be dumped out, used in water and sand play, or sorted by color or size; and when the child finally masters assembling them together he or she has learned size discrimination. When using the same toy with a child with an ASD his play and exploration might be limited to rolling the cup across the floor. When working with Legos he would perhaps line them up rather than putting them together into any one of a myriad of things. 

So much of our early learning is encouraged by play; experimentation, learning new concepts, synthesis of new ideas, and planning and problem solving are all nurtured by a creative, diverse play experience.

When interacting with toys the child with an ASD appears to not see the toy as a whole but focuses in on details like the wheels on a car, or flipping the pages in a book back and forth without ever looking at the pictures. This form of repetitive play restricts and limits the child’s exploration and learning.

Children with ASD also often develop an attachment to a particular object or toy sometimes to the preclusion of playing with any other toy. This limits learning and social opportunities.

While repetitive play issues may be caused by an underlying issue such as OCD or an anxiety disorder, many children with ASD may use these behaviors because they find them to be soothing, increasing levels of arousal, or providing homeostasis or balance. There is also the possibility that these behaviors might be the result of an inability to understand how to interact with play objects. For instance, if a child is overly focused on the texture of the tires on a toy car, he or she may not understand that the car could possibly roll along on those tires to exciting new places.

Perseveration, a common hallmark of ASD, happens when a person repeats an utterance, a thought, or a gesture long after its usefulness has ended. This is marked by a strong resistance to change. Persevering is the ultimate goal of these actions; the problem is that these actions interfere with purposeful activity. Activities such as repeating phrases, flapping hands, ritualistic behavior, and "stimming" interfere with social activity and can isolate the child from learning activities by disrupting group interaction. 

Following is an example of perseverative behavior; a young child with ASD engaging in repetitive behavior  that may seem to be meaningless to the onlooker, but may have a specific purpose for the child.

Note that the above child repeats a ritualistic behavior at the oven door in spite of the repeated attempts at communication made by the child's caregiver. 

Perseverative behaviors may provide a sense of structure and comfort to the autistic child; it has been noted that many non-autistic people engage in ritualized, repetitive behaviors and find great comfort in them.

Self injurious behaviors are actions that a child performs that can result in direct physical harm to the child's own body.

Many children with ASD engage in self-injurious behaviors; such as biting, headbanging, or hitting oneself with hands.  These behaviors are often seen as very aberrant and disturbing and can be very socially isolating. It is not fully understood why some children with autism self injure. One theory is that children with ASD engage in hitting or hurting themselves in order to get the attention of parents or caregivers.

A similar theory is that a child may engage in self-injury in order to avoid demands that are placed on them; attention is taken away from expectations and focused on stopping the self-injurious behavior, giving the child positive reinforcement for continuing the behavior.
 

Another theory is that the release of chemicals into the brain that are pleasurable, such as endorphins, may occur when an individual self injures. Some research suggests that children may continue to injure themselves because it makes them feel good. 

Most children are thought to have highly complex reasons for self injury that are not fully understood. Most research indicates that it is a combination of these and other things that lead to self injury.
 

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References: 

Honey, Emma; Leekam, Sue; Turner, Michelle: McConachie, Helen: Repetitive Behaviour and Play in Typically Developing Children and Children with Autism Spectrum Disorders 2006

Turner, Michelle: Annotation: Repetitive Behaviour in Autism: A Review of Psychological Research, 1999 


Kuhaneck, Heather M.; Watling, Renee: Autism: A comprehensive Occupational Therapy Approach